Global HIV control: is the glass half empty or half full?

Abstract

The massive scale-up of HIV treatment and prevention over the past two decades has resulted in important reductions in new infections and mortality globally. Reduction in HIV incidence, however, has been unequal, with worsening epidemics in regions where the reach and scale of HIV control programmes have been insufficient, especially in eastern Europe, central Asia, the Middle East, north Africa, and Latin America where HIV epidemics are concentrated among key populations, including people who inject drugs, men who have sex with men, transgender people, and some minority racial and ethnic groups. The global state of the HIV pandemic highlights disparities in HIV control efforts and provides a roadmap for what should be done, including investment to better implement the effective HIV prevention and treatment tools that are available, but whose adoption and scale-up are not yet sufficient to get us close to an AIDS-free generation. To achieve the full potential of global HIV control, we call for urgent, evidence-informed implementation at scale of our existing and novel HIV prevention and treatment strategies in ways that are better, faster, more efficient, and cost-effective, especially in key populations and regions where the HIV pandemic continues to expand.

Figure 1:

UNAIDS 2022 estimates of percentage change in HIV incidence since 2012¹

Figure 2:. UNAIDS 2022 estimates of HIV testing and treatment cascade

(A) Global. (B) Eastern Europe and central Asia. (C) Eastern and southern Africa. (D) Middle East and north Africa. (E) Latin America. (F) Rate of viral suppression in people with HIV in the USA. Numeric data are point estimate (95% CI). Source: Health Resources and Services Administration.